why does it have to be this hard?
I've spent 3 hours on the phone in the last two days trying to get Dylan's last 2 clinic appointments billed correctly to my insurance company.
Most of that time has been with UNMH's two different billing depts.
At the first clinic appt I was really pleased to see that the labs are run by Tricore... Tricore is 'in network' for me, meaning I don't have a co-pay for anything other than x-rays. UNM is not 'in network' for me, meaning I have to pay 40% after a $300 deductable.
well, of course the labwork was billed under UNMH's tax id, which translates to about $500.00 worth of lab bills on top of the actual clinic visits. I've got another $300 worth of bills coming for those.
This whole thing just sucks.
She needs to go to the clinic at UNM... they are the only providers 'blessed' by the cystic fibrosis foundation in the entire damn state.
My insurance has a clause in it that allows for an out of network provider to be covered at in network rates if there is not sufficent care provided by in network providers for a specific dx. (got that? it's a mouthfull). So, with that said, and knowing that UNMH is the only CFF certified clinic in NM you would think that it would be pretty easy to get the clinic visits covered as in network huh?
you would be wrong. PHS has a single peds. pulmonologist in the professional building that claims to be a CF specialist. My insurance company is saying that because he exists, there is sufficent coverage in network for cystic fibrosis treatment.
He didn't even know there was a clinic in town...
Dylan has NO pulmonary symptoms at this time...
The in network GI doesn't feel comfortable treating her - he told us to go to the clinic...
When I asked him to write a letter to the insurance company explaining that in his prof. opinion she needed to be seen at the clinic at UNM he wrote out an RX and faxed it to the insurance company...
I swear. at this rate I need a full time person just to deal with this. She's not even really sick right now. I would hate to see what would happen then.
I'm starting to think that it would be easier and cheaper to have her treated in Phoenix. The CF clinic there is in network for me... that means I would pay my $25 copay and be done.
Hey Bu... If it comes to that can we maybe stay with you overnight once a quarter?
I'm only half joking.
Most of that time has been with UNMH's two different billing depts.
At the first clinic appt I was really pleased to see that the labs are run by Tricore... Tricore is 'in network' for me, meaning I don't have a co-pay for anything other than x-rays. UNM is not 'in network' for me, meaning I have to pay 40% after a $300 deductable.
well, of course the labwork was billed under UNMH's tax id, which translates to about $500.00 worth of lab bills on top of the actual clinic visits. I've got another $300 worth of bills coming for those.
This whole thing just sucks.
She needs to go to the clinic at UNM... they are the only providers 'blessed' by the cystic fibrosis foundation in the entire damn state.
My insurance has a clause in it that allows for an out of network provider to be covered at in network rates if there is not sufficent care provided by in network providers for a specific dx. (got that? it's a mouthfull). So, with that said, and knowing that UNMH is the only CFF certified clinic in NM you would think that it would be pretty easy to get the clinic visits covered as in network huh?
you would be wrong. PHS has a single peds. pulmonologist in the professional building that claims to be a CF specialist. My insurance company is saying that because he exists, there is sufficent coverage in network for cystic fibrosis treatment.
He didn't even know there was a clinic in town...
Dylan has NO pulmonary symptoms at this time...
The in network GI doesn't feel comfortable treating her - he told us to go to the clinic...
When I asked him to write a letter to the insurance company explaining that in his prof. opinion she needed to be seen at the clinic at UNM he wrote out an RX and faxed it to the insurance company...
I swear. at this rate I need a full time person just to deal with this. She's not even really sick right now. I would hate to see what would happen then.
I'm starting to think that it would be easier and cheaper to have her treated in Phoenix. The CF clinic there is in network for me... that means I would pay my $25 copay and be done.
Hey Bu... If it comes to that can we maybe stay with you overnight once a quarter?
I'm only half joking.